i can be smooth and charming and slick. ican make a very confident impression and it's hard to leave me at a loss for words. sometimes i find myself fantasizing aboutunlimited success and power, and beauty. i have repeatedly used deceit to cheat, con,or defraud others for my personal gain. to be honest, i don't have much concern for thefeelings of other people, or their suffering.
crash diet vs, doesn't sound like the hank you know, doesit? these are all statements from the self-assessmentmeasure for personality disorders, that lets patients describe themselves, ranking each statementin terms of how accurate they think it is. to be honest, you can't rely too much on thiskind of self-reporting to assess what we are
talking about today because while some peoplewho are over-confident or obsessed with power or downright deceitful might tell you thatthey are, there is a certain subset that won't. many of the disorders that we have talkedabout so far are considered, "ego-dystonic" meaning that people who have them are awarethat they have a problem and tend to be distressed by their symptoms. like a person with bipolar disorder or ocdgenerally knows that they have a psychological condition and they don't like what it doesto them. but some disorders are trickier then that.they are "ego-syntonic," the person experiencing them doesn't necessarily think that they havea problem and sometimes, they think the problem
is with everyone else. personality disorders fall into this category.these are psychological disorders marked by inflexible, disruptive, and enduring behaviorpatterns that impair social and other functioning -- whether the sufferer recognizes that or not. unlike many other conditions that we've talkedabout, personality disorders are often considered to be chronic and enduring syndromes thatcreate noticeable problems in life. and as you can tell from these self assessmentstatements, they can range from relatively harmless displays of narcissism, to a trueand troubling lack of empathy for other people. not only can personality disorders be difficultto diagnose and understand, they can also
be downright scary. most of the extreme andsevere disorders go by names that you probably recognize: psychopathy and sociopathy. i'm talking,like, serial killers here, mob bosses, vlad the impaler. cultures have been studying human personalitycharacteristics for thousands of years, but the concept of personality disorders is amuch newer idea. much of our modern classifications of thesedisorders are based on the work of german psychiatrist, kurt schneider, who was oneof the earliest researchers into what was then known as psychopathy and published atreatise on the study in 1923. today, the dsm 5 contains ten distinct personalitydisorder diagnoses, grouped into three clusters. the first cluster, cluster a, includes whatare often labeled simply as "odd" or "eccentric"
personality characteristics. for example,someone with paranoid personality disorder may feel a pervasive distrust of others andbe constantly guarded and suspicious while a person with a schizoid personality disorderwould seem overly aloof and indifferent, showing no interest in relationships and few emotionalresponses. cluster b encompasses dramatic emotional orimpulsive personality characteristics. for example, a narcissistic personality can displaya selfish grandiose sense of self-importance and entitlement. meanwhile, a histrionic personalitymight seem like they're acting a part to get attention, even putting themselves at riskwith dramatic, dangerous, and even suicidal gestures. the behavior of cluster b can betruly self-destructive and frightening, and
these disorders are often associated withfrequent hospitalization. finally, cluster c encompasses anxious, fearful,or avoidant personality traits. for example, those with avoidant and dependent personalitydisorders often avoid meeting new people or taking risks and show a lack of confidence,an excessive need to be taken care of, and a tremendous fear of being abandoned. now,in the past, and, to a great extent, today, some of these categories have been controversial.many researchers argue that some of these conditions overlap with each other so muchthat it can be impossible to tease them apart. narcissistic personality disorder, for example,has many traits that resemble histrionic personality disorder. and because of this gray area, themost commonly diagnosed personality disorder
is actually personality disorder not otherwisespecified or pdnos. the prevalence of this diagnosis suggests that while clinicians canidentify a personality disorder in a patient, figuring out the details of the conditioncan be messy and difficult. one proposed alternative for diagnosing thesedisorders is the dimensional model, which, in essence, gets rid of discrete disordersand replaces them with a range of personality traits or symptoms, rating each person oneach dimension. so the dimensional model would assess a patient not with the aim of diagnosingone disorder or another, but instead, simply finding out that they rank high on say, narcissismand avoidance. it's a work in progress, so with another generation, the clinical definition of"personality disorder" may evolve pretty radically.
one of the best-studied personality disordersright now is borderline personality disorder, or bpd. borderline makes it sounds like patientsare like, pretty close to being healthy, but not quite, but that is not at all the case.bpd sufferers have often learned to use dysfunctional, unhealthy ways to get their basic psychologicalneeds met, like love and validation, by using things like outbursts of rage, or on the otherend of the spectrum, self-injury behaviors like cutting or worse. people with bpd wereonce commonly maligned by clinicians as 'difficult' or 'attention-seeking', but we now understandbpd as a complicated set of learned behaviors and emotional responses to traumatic or neglectfulenvironments, particularly in childhood. in a sense, people with this disorder learn thatrage or self-harm helped them cope with traumatic
situations, but as a result, they also endup using them in non-traumatic situations. although challenging for patients and cliniciansalike, the good news is that some psychotherapies have helped even the most severely suffering,repeatedly hospitalized bpd patients. but probably the most famous well-established,and frankly, troubling personality disorder is antisocial personality disorder. now, you've heardof this before, but maybe by one of its now somewhat out of vogue synonyms, "psychopathy"or "sociopathy." people with antisocial personality disorder, usually men, exhibit a lack of consciencefor wrongdoing, even towards friends and family members. their destructive behavior surfacesin childhood or adolescence, beginning with excessive lying, fighting, stealing, violence,or manipulation. as adults, people with this
disorder are thought to generally end up inone of two situations: either they are unable to keep a job and engage in violent criminalor similarly dysfunctional behavior; or they become clever, charming con-artists, or ruthlessexecutives who make their way to positions of power. tony soprano would have qualifiedfor a diagnosis, even if he wasn't nearly as bad as, say, serial killer ted bundy orvlad the impaler, the infamous 15th century romanian prince who personally watched about100,000 people get impaled or have the skin of their feet licked off by goats. yeah. that happened. despite this classic remorselessness, lackof empathy, and sometimes criminal behavior,
criminality is not always a component of antisocialbehavior. certainly many people with criminal records don't fit that psychopathic profile.most show remorse, love, and concern for friends and family. but still, although anti-socialpersonalities make up just about 1% of the general population, they were estimated in one studyto constitute about 16% of the incarcerated population. so, how might someone end up with such a disturbingdisorder? well, as you might expect, the causes are probably a tangled combination of biological andpsychological threads, both genetic and environmental. although no one has found a single geneticpredictor of antisocial personality disorder, twin and adoption studies do show that relativesof those with psychopathic features do have a higher likelihood of engaging in psychopathicbehavior themselves. and early signs are sometimes
detected as young as age three or four, oftenas an impairment in fear conditioning, in other words, lower than normal response tothings that typically startle or frighten children like loud and unpleasant noises.most kids only need to get burned by a hot dish once to know to stay away, but kids whoend up displaying antisocial personalities as adults don't necessarily connect or care aboutthe learned consequences when they're little. from there, like we've seen in other disorders,genetic and biological influences can intersect with an abusive or neglectful environmentto help wire the personality in a peculiar and damaged way. while the vast majority oftraumatized people don't grow up to be killers or con-artists, genes do seem to predispose somepeople to be more sensitive to abuse or trauma.
meanwhile, studies exploring the neural basisof antisocial disorder have revealed that when shown evocative photographs, like a childbeing hit or a woman with a knife at her throat, those with psychopathic personality featuresshowed little change in heart rate and perspiration, as compared to control groups. and the classic antisocial lack of impulsecontrol and other symptoms have also been linked to deficits in certain brain structures.one study compared pet scans from 41 people convicted of murder to those of non-criminalsand found that the convicted killers had greatly reduced activity in the frontal lobe, an areaassociated with impulse control and keeping aggressive behavior in check. in fact, violentrepeat offenders had as much as 11% less frontal
lobe tissue than the average brain. theirbrains also responded less to facial displays of stress or anguish, something that's alsoobserved in childhood, so it's possible that some antisocial personalities lack empathybecause they simply don't or can't register others' feelings. research has also suggestedan overly reactive dopamine reward system, suggesting that the drive to act on an impulseto gain stimulation or short-term rewards regardless of the consequences may be moreintense than the average person's. as we mentioned before, because personalitydisorders are pretty much egosyntonic by definition, people don't often acknowledge that they havea problem or a need for treatment - and in the case of antisocial personality disorder,even if they did, there aren't many specific
treatments available, at least not for adults. but there are some promising interventionsfor kids and adolescents whose minds and brains are more plastic and adaptable. in this way,the best way to treat antisocial personality disorder may be in trying to prevent it. accordingto american psychiatrist donald w. black, among others, many kids diagnosed with conductdisorder, the diagnostic precursor to antisocial disorder, are at high-risk for developingantisocial personalities as adults. but by identifying warning signs early on and byworking with these kids and families to correct their behavior and remove negative influences,some of that impulse fearlessness could be channeled into healthier directions, liketo reward promoting athleticism, or a spirit
of adventure. it's important to remember thatantisocial personality disorder is only one type of personality disorder. this is a diversefamily of psychological conditions determined by many different factors and we're stillin the early stages of diagnosing and understanding the mechanisms behind them. today, you learned about personality disordersand the difference between ego-dystonic and ego-syntonic disorders. we looked at the threeclusters of personality disorder, according to the dsm v, and how personality disordersymptoms often overlap. we also took a look at borderline and antisocial personality disorders,including their potential bio-psycho-social roots. thank you for watching, especially to allof our subbable subscribers, without whom
we could not make crash course. to find outhow you can become a supporter, just go to subbable.com/crashcourse. this episode was written by kathleen yale,edited by blake de pastino, and our consultant is dr. ranjit bhagwat. our director and editoris nicholas jenkins, the script supervisor and sound designer is michael aranda, andthe graphics team is thought cafe.
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